Oral health inequalities and health systems in Asia-Pacific: A call for action

Marco Peres, David Brennan & Madhan BalasubramanianAsia-Pacific is home to about half the world’s
population. It is a diverse region comprising 38 countries, including the World
Health Organ­ization’s Western Pacific and South-East Asian regions. Six coun­tries
(Australia, Brunei, Japan, New Zealand, South Korea and Singapore) are
high-income; two are low-income (Nepal and North Korea), and rest are clas­sified
as middle-income. China, India, Malaysia, Thailand, Indonesia, and the
Philippines are among the fastest growing economies in the world. Health is an
intrinsic factor in economic development in the region1, and central towards achieving global
Sustainable Development Goals2, 3.

Oral health describes the
health of the mouth and adjacent structures. Tooth decay, gum disease and tooth loss rank among the
most common con­ditions in the world4. They cause pain, infection, difficulty in
eating, and can have a negative impact on quality of life and social
functioning. Oral diseases are also linked with other systemic conditions, such
as cardiovascular diseas­es5,6. The cost of treating oral diseases account for
a large proportion of overall expenditure on health. For example, direct
treatment costs of oral diseases were estimated at US$298 billion a year
globally, an average of 4.7% of the global health expenditure7. Even
though oral diseases are largely preventable, oral healthcare is a neglected
area and given low priority in most systems8.

Oral health inequalities and health systems

In simple terms, oral health
inequalities refer to the uneven distribution of oral health or oral health
resources amongst the population. Oral diseases dis­proportionately affect the
poor and socially disadvantaged, who are have great­er exposure to risk factors
and have inadequate access to necessary health services. Denied or delayed
access to dental care is influenced by factors such as the availability of
practitioners and cost of dental services. Inequalities in oral health are seen
both within and across several countries in the Asia-Pa­cific region. The
global dental research community has consistently argued that these
inequalities are both unfair and unjust and demand the immediate attention or
policy-makers9.

A health system comprises
all organizations, people and actions whose aim is to promote, restore or
maintain health10. Strengthening these
systems is fundamental to address oral health inequalities and this include
efforts to influence determinants of health as well as more direct
health-improving ac­tivities. The six building blocks of health systems
include: workforce, service delivery, information; medical/dental products;
technologies; financing; and leadership and governance10.

The oral health workforce in
the region is primarily made of dentists. Mid-level providers (such as nurses,
hygienists and assistants), who could provide a range of preventive services
and be more readily available in areas of need, have been neglected in many
countries. An appropriate mix of den­tal personnel, together with improved
teamwork and collaboration with other health professionals is necessary to
address oral health inequalities. Further, dental service and health financing
models may require revamping to be more effective at reaching the under-served.
In general, health systems research has been minimal, and there is a lack of
information and quality evidence from developing countries in the region.
Strengthening leadership and governance is necessary to address many health
systems challenges in the region.

Purpose of the special issue

This special issue is an effort to address key
challenges facing oral health inequalities and health systems in the
Asia-Pacific region. We have brought together a group of experts who strengthen
the call for action in the region. All the authors are senior academic or
policy personnel who have made a sig­nificant contribution to oral health
research regionally and globally.

In the first section, we
bring together four commentaries that focus on pertinent issues across several
countries in the Asia-Pacific region. David Wil­liams and Manu Mathur make a
case for including oral disease prevention and control in the broader
non-communicable disease framework. Ankur Singh presents an interesting case of
social determinants of oral health inequalities while Jun Aida discusses broad
challenges facing oral health inequalities in the region. Madhan
Balasubramanian, Jennifer Gallagher, Stephanie Short and David Brennan, focus
on dentist migration and workforce inequalities in the region.

Significance and future implications

There is an urgent demand for collaboration among
researchers, policymak­ers, public health practitioners, clinical teams and
public, to improve oral health in the Asia-Pacific region. Based on the London
Charter for Oral Health Inequalities9, we stress the importance of advocacy on oral
health inequalities in the region. We widen the agenda to strengthen essential
aspects of health systems in the region, such as dental workforce, service
delivery, organisation of care, health financing, governance and leadership.

This call for action aligns with the objectives
of research groups, such as the International Association for Dental Research
and Global Oral Health In­equalities Research Network and professional groups
such as the FDI World Dental Federation.
We also believe that the dental community needs to work more closely
with the World Health Organization, so as to develop tangible solutions to
address oral health inequalities and health systems strengthening in the
region.

We hope that this issue will be informative for
policy-makers, and useful for the dental industry, dental schools, health
professionals and the general public throughout the Asia-Pacific region.

1Professor of Population Oral Health and Director of the Australian Research Centre for Population Oral Health (ARCPOH), Adelaide Dental School, University of Adelaide, Australia (marco.peres@adelaide.edu.au); 2Professor, ARCPOH, Adelaide Dental School, the University of Adelaide, Australia (david.brennan@adelaide.edu.au); 3Research Associate, ARCPOH, Adelaide Dental School, University of Adelaide, Australia; Honorary Associate, Discipline of Behavioural and Social Sciences in Health, Faculty of Health Sciences, University of Sydney (madhan.balasubramanian@adelaide.edu.au).